| NPI | 1609986124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 12272) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: TX 12272) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-02-28 |